MeRIT Project: Assessment of medication adherence rates and risk factors associated with low medication adherence in high risk obstetric patients

Introduction: Women who do not take their chronic medications during pregnancy are more likely to have uncontrolled disease, increasing the risk of adverse outcomes such as preterm birth, low birthweight, and cesarean delivery.

Objectives: Quantify chronic medication adherence rates and identify factors associated with low medication adherence during pregnancy in a predominantly urban, Medicaid population.

Study Design: This is a prospective cross-sectional study, initiated in February 2016 in the High Risk Obstetrics (HROB) Clinic at the University of Illinois at Chicago (UIC). Eligible pregnant are prescribed at least one medication for asthma, diabetes, depression, hypertension, epilepsy, or thyroid disorder.

Methods: Eligible patients provide informed consent and completed a survey which includes demographic questions, Morisky 8 medication adherence score (MMAS-8), medication adherence reasons scale (MARS), and the rapid estimate of adult literacy in medicine (REALM-SF), and pregnancy specific questions. Pharmacy records were requested to evaluate a medication possession ratio (MPR) but have not been received. Participants were compensated with a $10 Amazon gift card.

Results: Forty patients were surveyed; 30% self-reported low medication adherence, 52% moderate, and 18% high via MMAS-8. There were no differences in baseline characteristics between low adherence and those with moderate or high adherence. While not statistically significant, women with low adherence had a higher percentage of smoking and marijuana use, and a higher number of prescribed chronic medications. Approximately 42% of patients in both groups had health literacy of ≤ 8^thgrade via REALM-SF scoring. Common reasons for missed doses include forgetting their dose (n=13), missing due to a busy schedule (n=9), or side effects (n=5).

Conclusions: Similar to previous studies, approximately one third of pregnant women self-reported low medication adherence. In this small sample size of preliminary data, there were no statistically significant differences identified between patients with self-reported low adherence versus moderate to high adherence in this small sample size of preliminary data.